Eligibility Representative - Accredo - Remote
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AI Summary
As an Eligibility Representative, you’ll be part of a dedicated team which helps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions. This role handles each inquiry with care, detail, and most importantly, empathy.
Here’s a little more on how you’ll make a difference:
PRIMARY RESPONSIBILITIES:
Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements.
Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements.
Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately.
Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems.
Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.
QUALIFICATIONS:
Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support.
Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information.
Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately.
Experience documenting insurance and authorization information with a high level of accuracy and attention to detail.
Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality.
Strong written and verbal communication skills appropriate for professional interactions with payer representatives.
High School Diploma or equivalent.
Must live and work remotely in one the following states: Alabama, Indiana, South Carolina, or Tennessee.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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